Should You Dump Your Primary Care Physician?

On a recent Sunday evening, Dr. Steven Knope, a physician in Tucson, Ariz., answered an urgent phone call from one of his 150 patients. The patient was experiencing extreme abdominal pain. The two met at Dr. Knope's office, where he diagnosed the discomfort as appendicitis.

But Dr. Knope's consultation did not end there. He met the patient at the emergency room and when the staff estimated a long wait, Dr. Knope advocated on his behalf, stressing that the condition was life threatening. Soon after, the patient was in the operating room.

This scenario, says Dr. Knope, is just one example of how a so-called concierge physician can offer superior services to those of a traditional physician. Doctors like Knope do not accept insurance and are paid directly by patients.

This relationship, in theory, leaves physicians able to serve far fewer patients while making the same income as a highly paid specialist. As a result, the doctor has time to accompany patients to appointments with other health care professionals, coordinate care with specialists and accommodate same-day visits.

The late-night or weekend calls are rare, says Dr. Knope, despite the fact that he gives his cellphone number to each patient. "That happens far less often," he says, "because you have the time to do the job right and most people are pretty tuned up."

The promise of such care can tempt even the most loyal patients to leave their primary care doctors. But switching to concierge medicine is a pricey investment that can cost up to $25,000 a year.

Before making the transition, it's important to consider the quality of care you already receive from your physician.

How It Works

At Dr. Howard Maron's Bellevue, Wash.-based practice MD2 (pronounced MD squared), individual patients pay an annual fee of $15,000 while a family of four pays $25,000. This covers the cost for every service that takes place in the doctor's office.

If a patient needs a special test, like an MRI or biopsy, patients then use traditional insurance to pay for it. This model, which Dr. Maron helped to pioneer in 1996 as the founder of MD2, is the standard for concierge practices.

MD2's fees are more expensive than most, but pricing depends on the location and size of the practice. MD2 doctors practice in Bellevue, Seattle, Chicago, Portland, Ore., and San Francisco; at each location a doctor handles just 50 families. Dr. Knope charges $6,000 for an individual and $10,000 for a couple and has 150 patients.

Similarly, the Boca Raton, Fla., company MDVIP, a network of more than 280 concierge physicians who have no more than 600 patients each, charges between $1,500 and $1,800 per patient, reducing the cost to as little as $125 per month.

There are an estimated 1,000 concierge physicians in the U.S., and the Society for Innovative Medical Practice Design, an organization of doctors who promote a direct financial relationship with patients, maintains a database of participating physicians on its Web site.

This dynamic can be a stark contrast from traditional primary care settings, in which a patient often tries to persuade a doctor to spend more time on his or her case. The average doctor tends to as many as 3,000 patients per year and schedules appointments in 15-minute blocks.

"When you sit down with your wealth manager, you don't advocate for yourself," says Dr. Maron, describing the shortcomings of the traditional patient-physician relationship. "You either trust that person or move on." Health care should work the same way, he says.

When to Switch

If you have lost confidence in your physician's ability to address your health concerns in a comprehensive way (the doctor has failed to treat chronic pain or recognize risk factors for certain diseases), then concierge medicine might be an appropriate alternative.

Dr. Maron, like many concierge physicians, sits down with a patient for longer periods of time to review his or her history in an effort to single out existing or potential health issues. Dr. Knope refuses to schedule more than two patients per hour and develops a prescriptive exercise and nutrition program for each patient as part of an annual physical.

While Dr. Joseph M. Heyman, chair of the Board of Trustees of the American Medical Association, is unaware of any studies evaluating the outcomes of patients with concierge physicians versus those without, he does admit that the smaller patient load can allow for a more personalized approach.

Still, he says, physicians "should provide the same quality of care to all patients regardless of the model of care in which they are practicing."

He also recommends that patients considering the switch discuss in detail what is covered under a retainer or concierge contract, and confirm with their health insurance provider that choosing a concierge physician does not violate their current policy.

Dr. Knope would choose a concierge physician if he could. As the only practicing concierge physician in Tucson, he has no access to the very services he offers patients.

"When my kid is sick at two in the morning I'd much rather be able to reach my pediatrician and have him meet us in the ER," says Knope. "Is that worth an extra $100 a month? Absolutely."